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What Is Advanced Hypertension?

Blood pressure is a measure of how hard blood pushes against blood vessel walls as it circulates in the body. Each beat of the heart pushes blood throughout the body. A blood pressure measurement shows the pressure created by the heart muscle as it contracts and relaxes. Blood pressure increases when the blood is forced out of the heart into the arteries (systole phase). Pressure decreases when the heart relaxes between beats (diastole phase). 

There are two numbers recorded when measuring blood pressure. The top number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The bottom number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are reported as millimeters of mercury (mm Hg). This represents how high the mercury column in the measuring device is raised by the pressure of the blood .

The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.

Advanced Hypertension Expertise

Norton Heart & Vascular Institute is a leader in advanced hypertension treatment. Norton Heart & Vascular Institute physicians are at the forefront of cardiovascular care such as the Symplicity Spyral renal denervation (RDN) system — also known as the Symplicity blood pressure procedure. This minimally invasive procedure targets nerves near the kidneys that can become overactive and cause high blood pressure. 

Our physicians are also researchers who lead clinical trials into new and experimental treatments. That means patients can get early access to leading-edge therapies, and once the treatments are approved for broad use, our physicians are already deeply experienced.

  • Normal blood pressure. Blood pressure is lower than 120/80 mm Hg.
  • Elevated blood pressure. The top number ranges from 120 to 129 mm Hg, and the bottom number is below, not above, 80 mmHg.
  • Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg, or the bottom number is between 80 and 89 mm Hg.
  • Stage 2 hypertension. The top number is 140 mm Hg or higher, or the bottom number is 90 mm Hg or higher.

Stage 2 hypertension, or advanced hypertension, is defined as a systolic blood pressure of 140 mm Hg or higher, or a diastolic pressure of 90 mm Hg or higher. This level of high blood pressure requires immediate medical attention. If left untreated, Stage 2 hypertension can lead to stroke, heart attack and serious damage to the kidneys, eyes and brain.

How Do I Know if I Have Advanced Hypertension?

High blood pressure often is called a “silent killer,” because there are usually no symptoms. This is why it is very important to have your health care provider take regular blood pressure readings. 

Your health care provider may do some tests on you, such as:

  • Ambulatory monitoring, which checks your blood pressure regularly over a 24-hour period
  • Lab tests of blood and urine
  • Electrocardiogram (ECG or EKG) to check for electrical activity of the heart
  • Echocardiogram that uses sound waves to show how the blood moves through the heart

You may be asked to check your blood pressure at home, using a home blood pressure monitor. 

Symptoms of Stage 2 Hypertension

Many people with advanced hypertension experience few or no symptoms. However, if you know you have high blood pressure, is important to regularly monitor your blood pressure and look for the development of the following: 

  • Severe headaches
  • Fatigue or confusion
  • Vision issues
  • Chest pain
  • Difficulty breathing
  • Irregular heartbeat

Causes of Advanced Hypertension

Two things determine blood pressure: the amount of blood the heart pumps and how hard it is for the blood to move through the arteries. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.

For most adults, there’s no known cause of high blood pressure. This type of high blood pressure is called primary hypertension or essential hypertension. It tends to develop gradually over many years. Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood pressure.

Secondary hypertension is caused by a known underlying condition. It tends to appear suddenly and cause higher blood pressure than does primary hypertension. Conditions and medicines that can lead to secondary hypertension include:

  • Adrenal gland tumors
  • Blood vessel conditions present at birth, also called congenital heart conditions
  • Cough and cold medicines, some pain relievers, birth control pills and other prescription drugs
  • Illegal drugs, such as cocaine and amphetamines
  • Kidney disease
  • Obstructive sleep apnea
  • Thyroid issues

Risk Factors 

  • Age. Your risk increases as you age. Until about age 64, hypertension is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is more common in African Americans. 
  • Genetics. You’re more likely to develop high blood pressure if you have a parent or sibling with the condition.
  • Obesity or higher weight. Excess weight causes changes in the blood vessels, the kidneys and other parts of the body. These changes often increase blood pressure. Being overweight or having obesity also raises the risk of heart disease and its risk factors, such as high cholesterol.
  • Lack of exercise. Not getting enough movement can cause weight gain. Increased weight raises the risk of high blood pressure. 
  • Tobacco use or vaping. Smoking, chewing tobacco or vaping immediately raises blood pressure for a short while. Tobacco smoking injures blood vessel walls and speeds up the process of hardening of the arteries.
  • Too much salt. This causes the body to retain water, which affects blood pressure.
  • Low potassium levels. Potassium helps balance the amount of salt in the body’s cells.
  • Too much alcohol. Alcohol use has been linked with increased blood pressure.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
  • Certain chronic conditions. Kidney disease, diabetes and sleep apnea are some of the conditions that can lead to high blood pressure.
  • Pregnancy. Sometimes pregnancy causes high blood pressure, called preeclampsia.

Treatments

Your treatment plan will be created based on your unique situation. Treatment options include lifestyle changes and medication.

Lifestyle changes

  • Dietary modifications — low salt intake, moderate intake or abstinence from alcohol, high-fiber and low-fat diet
  • Increased physical activity
  • Stopping smoking

Medications

Your health care provider can talk to you about whether medications are right for you, based on factors such as your age and any chronic conditions, such as heart disease or kidney disease. Your doctor will determine your goal blood pressure reading and prescribe one or more medications to lower blood pressure. The include:

  • Diuretics (water pills) that help your body flush out salt and water
  • Medications that relax the muscles around the blood vessels 

Complications

Over time, severe hypertension damages the arteries. Fat in the bloodstream can snag on these damaged parts and build up. This makes the artery walls less flexible and limits healthy blood flow. 

Constant pressure in the arteries can cause the artery wall to bulge and burst. This is called an aneurysm. 

Heart failure occurs when the heart muscle becomes weakened or stiff. The heart cannot keep up with the body’s demand for fresh, oxygen-rich blood and slowly fails over time.

Brain damage or stroke can occur when the blood supply to the brain is affected. Research has shown there is a link between hypertension and dementia

Kidneys can be damaged from high blood pressure. The kidneys filter extra salt and fluids from your body, and severe hypertension can damage the many blood vessels of this organ. When the kidneys can’t filter properly, they begin to fail. 

Hypertension can damage the delicate blood vessels of the eye, causing bleeding or vision loss.

Sexual dysfunction is a complication of high blood pressure. For men, erectile dysfunction is common as a person ages, but in those with uncontrolled blood pressure, the ability to get and keep an erection is more likely. In women, high blood pressure can reduce blood flow to the vagina, leading to decreased sexual desire, vaginal dryness or difficulty reaching orgasm.

Prevention

Sometimes there is no clear cause of severe hypertension. But there are some ways to reduce your chances of developing this condition, including:

  • Losing excess weight. Higher weight can contribute to high blood pressure and sleep apnea, a condition that affects good sleep and is linked to heart disease
  • Getting regular aerobic exercise. Activities including swimming, dancing, walking, jogging and strength training may help lower blood pressure. Aim for 30 minutes each day. 
  • Eating a healthy diet, limiting sugar and lowering salt intake. Consuming whole grains, fruits, and low-fat dairy products can help lower blood pressure. Also, limiting alcohol to less than one drink per day for women or two drinks a day for men can keep risks lower for high blood pressure.
  • Quitting smoking. There are many reasons to quit smoking, and one of them is to help lower blood pressure. 
  • Reducing stress. Long-term stress may be a risk factor for high blood pressure. Talk to your health care provider or a counselor about ways to identify sources of stress in your life and how to reduce it.
  • Having annual physicals. You should see your primary care physician once a year for a checkup, including a blood pressure reading and a cholesterol check.
  • Getting enough sleep. Lack of sleep can play a role in advanced hypertension. Aim for seven to nine hours a night.

Managing Advanced Hypertension

There is no cure for hypertension, but advanced hypertension should be controlled and managed to avoid developing future health issues. 

  1. Medications
  2. Lifestyle modifications
  3. Minimally invasive procedures 

Norton Heart & Vascular Institute is the first health care system in the state of Kentucky to use Symplicty Spyral renal denervation (RDN) system — also known as the Symplicity blood pressure procedure to treat advanced hypertension.

Next Steps

If you have not had a checkup with your primary care doctor, make an appointment. Before your appointment, be sure to have a list of any current medications, including over-the-counter medicines and supplements. Avoid caffeine, tobacco and exercise for at least 30 minutes before your appointment. Be prepared to discuss your exercise habits, your health history and your family health history, your smoking status, and how much alcohol you drink. Be prepared to take notes or record the conversation or take a friend or family member with you. 

About Norton Heart & Vascular Institute

Norton Heart and Vascular Institute offers advanced care at all of our adult-service hospitals to save hearts and lives.

Awards and Accreditations

  • All of Norton Healthcare’s adult-service hospitals in Louisville have received Chest Pain Center accreditation from the American College of Cardiology (ACC).
  • Norton Audubon Hospital has been named a HeartCare Center National Distinction of Excellence year after year by the American College of Cardiology. This is the only hospital in Louisville to be recognized for this distinction.
  • Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Hospital all are recognized as having ACC Chest Pain Center with Primary PCI accreditation.
  • Norton Audubon Hospital earned ventricular assist device (VAD) accreditation from DNV and the Centers for Medicare & Medicaid Services.

Leading the Region in Advanced Care

  • First in Louisville to implant a dual-chamber leadless pacemaker
  • First in Louisville to use PASCAL and MitraClip to replace and repair heart valves
  • First health care system in Louisville to offer CathWorks FFRangio System in a minimally invasive procedure used to treat clogged arteries and advance heart disease
  • Highest survival rate in the nation for  extracorporeal membrane oxygenation (ECMO) interventions treating heart failure
  • Among the highest survival rates in the nation for treatment of cardiogenic shock in heart failure
  • Over 100 transcarotid artery revascularization (TCAR) procedures performed for heart disease patients
  • System with the most facilities across the city of Louisville with the ability treat a life-threatening heart attack
  • More than 100 board-certified physicians and advanced practice providers with specialized heart and vascular training and experience at nearly 30locations in Louisville and Southern Indiana

Comprehensive Heart Care for the Whole Person

Norton Heart & Vascular Institute offers patient resources to support you and your family, including free classes for people of all ages who want to improve cardiovascular health or are living with a heart condition.

  • Cardiac rehabilitation: Our cardiac rehabilitation providers are leaders in developing and applying innovative techniques that can help you recover and resume your life.
  • Connecting Hearts for Support group: The group provides education and support to individuals who have had a heart attack, are living with a heart condition or are at risk for cardiovascular disease.
  • Heart health screenings: Prevention is the best way to manage heart disease, and screenings are available to detect early signs of cardiac and vascular disease and identify risk factors.

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